Chest tubes are inserted to drain fluid or air from the pleural space and allow the lung to re-expand; they are connected to underwater seal drainage to maintain suction and allow fluid to drain via gravity while monitoring for fluctuations, bubbles, and output; nurses must carefully monitor patients with chest tubes and the drainage systems to ensure proper functioning and prevent complications.

1. Care of Client
with under water
seal drainage

2. is a flexible plastic
tube that is inserted
through the side of the
chest into the pleural
space to reexpand
the lung.

4. Purpose
 Itis used to remove air , fluid or pus.
 To establish normal negative
pressure in the pleural cavity for
lung expansion.
 To equalize pressure on both sides
of the thoracic cavity.
 To provide continuous suction to
prevent tension pneumothorax.

5. Indication
 Pneumothorax: accumulation of air
 Pleural effusion: accumulation of fluid
 Chylothorax: a collection of
lymphatic fluid
 Empyema: a pyogenic infection of
the pleural space
 Hemothorax: accumulation of blood
 Hydrothorax: accumulation of serous
fluid

6. Contraindication
Bleeding
diathesis
Coagulopathy

7. Pre Procedure
1. Confirm the procedure
2. Inform patient
3. Check for the consent
4. Prepare the equipments
5. X-ray (with the report to
determine the affected lung)
6. Position patient

8. Observe/monitor patient’s
Respiration
Saturation
Reduce patient’s anxiety
Prepare the under water seal
Connect the closed system fast

9. Post procedure
 Monitor vital signs
 15min x 1 hour
 30mins x 1 hour
 1 hour x 4 hours and until stable
 Take note of the respiration
 Rate
 Pattern
 Rhythm
 Check saturation
 Administer oxygen when necessary

10. Post procedure
1. Care of patient
Respiratory status
Auscultates lungs to assess air
exchange in the affected
lung
Place patient in fowler’s
position

11.  Change the gauze when
necessary
 Strict aseptic technique when
performing dressing
Check skin integrity
o Redness
o Swelling
o Loose suture

12.  Intact and taped
 Maintain patency
 Check for obstruction
 Teach patient on how to take care of the
tubing
 Place a pillow between patient and tubing
 Coil the tube
 Avoid dependent loop
 Instruct patient to cough if tube is blocked
 Milking and stripping of the tube when
blocked

13.  Use rubber tips
 Clamped at the bedside
 Clamping
 During transfer
 Not more than 1 minute
 Upon doctor’s order
Note: clamping chest tube will accumulate
in the pleural cavity since the air has no
means of escape. This can rapidly lead to
tension pneumothorax.

14. 3 principles of under water
seal
Gravity
Water seal
Suction

15. Enhances flow from high to low.
Place below patient’s chest wall
(gravity)
Fill with sterile water.
Rod must be immersed 2cm in
water.
Observe for the fluctuation of
water level.

16. 5(a) Fluctuation
 To ensure the patency of the
system
 It will stop when :
 lung fully expanded
 an obstruction
Check for obstruction
 Tubing –kinked
 Patient’s position
 Ask patient to take a deep
breath and cough

17. 5(b) Bubbling
 Intermittentbubbling : normal
 Continous bubbling : abnormal
 Check :
Wound
Tube
Connection
 If rapid bubbling without air leak :
inform doctor immediately

18. 5(c) Drainage output
70-100 mls per hour
 observe for any change in
drainage colour
Mark the amount
Document in I/O chart
Change bottle every 24hours
or when full

19. 6. Suction apparatus
1. Low suction pump
 Must be controlled
 Suction valve / meter is inserted for wall
suction
 Check for bubbling
 If no bubbling
 Clamp chest tube to check for air
leaks
 Check tubing and connection
 Observe patient’s condition while chest
tube is clamped.

20. 7. Safety
1. Tube
 Prevent kinking
 Place a pillow as barrier
 Never clamp unnecessarily
2. Bottle
 Must be below chest
 Keep bottle in basin
 Inform relatives and housekeeping

21. 8. Ambulation
Encourage patient to
change position to
promote drainage
No need to clamp the
tube
Maintain chest tube below
chest wall

22. 9. Exercise
Encourage deep breathing and
arm exercise.
On the first post op day.
When patient not in severe pain.
Assist patient.
To enhance the lung expansion
Prevent stiffness of the arm

23. 10. Comfort
Administer analgesic in the
first 24hours.
Allow position that
comfortable to the patient .
Assist patient in daily living
activity
Hygiene

24. Removal of chest tube
Assessment
X-raydone to check the
progress
Clamp for 2 hours
Chest tube removed

25. Emergency care
Bleeding
Observe wound dressing
Observe drainage
Dislodgement
From insertion site : place a
gauze immediately
From connection : clamp
chest tube immediately

26. Emergency care…
Bottle breaks
Identify either patient having
pneumothorax or hemothorax.
Observe patient for tension
pneumothorax.
Place tube in saline immediately.
Unclamped immediately. (prevent
respiratory distress)
Elevation of bottle
Immediately inform doctor

27. Complication
Bleeding
Pulmonary embolus
Cardiac tamponade
Atelectasis